Role of context in affective theory of mind in Alzheimer's disease

Abstract

Affective theory of mind (ToM) is defined as the ability to deal with affective mental states. Attributing an affective mental state from a facial expression relies mainly on processes that allow information in the environment to be perceived and decoded. Reasoning processes are required when information is not directly available in the environment (e.g., when making an affective mental state attribution in a social situation where there is no visible facial expression of emotion). Although facial emotion decoding deficits have been reported in Alzheimer's disease (AD), few studies have assessed emotional reasoning processes. Long-term social knowledge may also contribute to mental state attribution, given its involvement in social situations, but the links between these two domains have not yet been properly explored. The aim of the present study was therefore to assess both decoding and reasoning processes in AD, as well as the effect of context on emotion attribution (i.e., whether prior presentation of a congruent vs. noncongruent social situation influences emotion recognition from faces). We also aimed to improve current understanding of the relationship between ToM processes and social knowledge. Participants were 20 patients with AD, 20 healthy older individuals, and 20 healthy young individuals. They performed three tasks testing ToM: a context task (emotion attribution in a social situation); a face task (facial emotion recognition); and a context-face task (determining whether the facial emotion was consistent with the emotion inferred from the social situation, e.g., an embarrassing situation followed by a proud face). All participants underwent a neuropsychological battery that included an assessment of social norm knowledge (e.g., determining whether it is socially acceptable to phone in a church). Results showed deficits in the patients with AD for decoding emotions from faces and for reasoning about emotions inferred from a social context. Patients were found to consider contextual information in such a way that congruency either helped or hindered the decoding of stimuli in the environment. As expected, we found that ToM abilities were linked to social norm knowledge. Overall, our findings suggest that patients with AD have difficulty attributing emotional mental states, and deficits in social norm knowledge and the presence of incongruent information may heighten this difficulty.

Empathy and Theory of Mind in Alzheimer’s Disease: A Meta-analysis

“…This disconnect between the cognitive and affective subcomponents of empathy aligns with conclusions from a recent qualitative review (Fischer et al, 2019). Similarly, some studies have found that individuals with AD are impaired in cognitive empathy (Castelli et al, 2011;Dodich et al, 2016;Duclos et al, 2018), while others have found no differences in affective empathy (Dermody et al, 2016;Nash et al, 2007). Importantly, unlike these prior studies, this study used meta-analytic methods which allowed the aggregation of mean effect sizes while controlling for sampling error (the most serious source of artefactual variance), thus providing a clearer understanding of how the different components of ToM and empathy are affected by AD.…”

“…The following studies were excluded because the data were not available (Martinez et al, 2018;Poveda et al, 2017;Rowse et al, 2013;Zaitchik et al, 2006). In certain instances, data were unavailable upon request due to specific participant groups not being assessed on the measures of interest (Cuerva et al, 2001;Dodich et al, 2016;Duclos et al, 2018;Fernandez-Duque, Baird, & Black, 2009;Youmans & Bourgeois, 2010). If participants scored at ceiling or floor on any measure, data for both control and AD participants from the measure in question were not permitted to contribute to the analyses.…”

<p>Neurocognitive mechanisms of theory of mind impairment in neurodegeneration: a transdiagnostic approach</p>

“…In this regard, the study by Synn et al16 is notable in demonstrating comparable difficulties on the ToM and “random movement” conditions of the Frith–Happé animations task, suggesting that ambiguity of stimuli and increasingly abstract task demands contribute to ToM impairments in AD 16. By contrast, with the provision of situational and social contexts, ToM deficits in AD are mitigated,79 presumably due to attenuation of the executive and mnemonic task demands. In summary, the bulk of evidence points to a domain-general impairment in ToM, attributable to a primary decline in memory, executive, and general cognitive abilities.…”

“…These processes may support the integration and maintenance of relevant information on ToM tasks, as well as facilitating the inference of mental states in the presence or absence of situational cues 77,78. With disease progression, increasing executive, visuospatial, and general cognitive dysfunction likely impact ToM performance, especially on tasks that tax visuospatial abilities or lack explicit situational cues 16,79. In this regard, the study by Synn et al16 is notable in demonstrating comparable difficulties on the ToM and “random movement” conditions of the Frith–Happé animations task, suggesting that ambiguity of stimuli and increasingly abstract task demands contribute to ToM impairments in AD 16.…”

“…Social function, however, hinges upon multifaceted interpersonal and contextual cues enabling us to interpret and understand other’s mental states (see also Ref. 79). Individuals with AD may find abstract tasks of ToM function overly cognitively demanding,16 yet if assessed within familiar and contextually rich social settings may display appropriate behavior.…”